Stent Replacement

Mark's first stent was placed in the bile duct on June 4th. Dr. Razzac explained that the duct was tight because of a tumor in the lymph node resting on it, cutting off bile flow. With radiation shrinking the cancerous tumor, he hoped the stent could be removed in two months. 

Today we arrived at Portland Providence Medical Center on Glisan at 11 am and were directed to the short stay department for the procedure to remove the stent. Mark was taken in at 1:30, and by 2:30, he was in recovery, where he stayed for almost two hours. Dr. Razzac visited and explained that he could remove the existing stent with no problem, but the lymph node is still pressing on the duct, so he had to replace the stent. He wanted to place two, but like last time, the duct was too tight, so it wasn't possible. We don't know if there is still a tumor inside the lymph node or swelling because of the radiation. 

There are permanent metal stents, but the surgeon doesn't like to use those, as they tend to cause other problems down the road. Also, scar tissue can form around the stent clogging the duct. The temporary stents are better if there is hope that one won't be needed in the future. We're counting on that, but that does mean another ERCP (Endoscopic Retrograde Cholangio-Pancreatography) in two months.

It was a much harder procedure than we were expecting. By the time we got home at 5:30 pm, the anesthesia had worn off, so Mark was in quite a lot of pain. However, a double dose of hydrocodone has helped him sleep, and he should feel better tomorrow. 

Unfortunately, the other pain below the liver on his right side has continued to increase so much that he has trouble sleeping. As I mentioned before, Dr. Taylor thinks it's from inflammation from the radiation. Hopefully, it, too, will subside soon.

Poor guy, he gets so tired of being in pain! We have such empathy for those who endure constant pain!! It's exhausting and discouraging. But, most of the time, Mark is in good spirits and is eager to be up and doing! 

Phew!

Two days after the last post, Mark started having pain in another area of his abdomen. Could another tumor be growing? It has continued in the intestinal region, lower than the liver, and often radiates to his back. However, he has continued to gain energy, and his nausea has decreased. Typically, when a tumor is growing, his energy level dips significantly. So, while it could be something else, our first concern is growing cancer cells!

Today, Mark had his infusion, which included an appointment with Dr. Taylor. The lab work was back by the time we saw him, so we reviewed the numbers together. Again, everything is moving in the right direction. Bilirubin counts are in range, as are liver and kidney numbers. It all looked great!

When Mark explained the location of the pain, Dr. Taylor felt confident that it is the result of the radiation. It is typical for areas around the tumor to become inflamed, which often causes pain. Unfortunately, it gets worse before it gets better, but it should resolve in several weeks. We are relieved!!  

The next PET scan is scheduled for August 16. We're, of course, hoping for a clean scan and life to return to some normality. It's been a crazy seven months, but we've been carried through, with your help and the help of heaven.

Celebration Day!!!

No More Radiation! As you can see, Mark was strapped in so he could not move and shoved into this tube where he had to be completely still for an hour to an hour and forty minutes. He struggles with claustrophobia, so this has been challenging, but with the help of Ativan, good music, self-talk, and prayer, he has made it through. But he's happy to have it over! In about six weeks, another PET will be done. The tumors will continue to shrink for some time, so it’s best not to have the scan too soon. 

Infusions of the immunotherapy drug, Keytruda will be administered every three weeks with hopes that it will keep other tumors from growing. In the past, Mark has handled it quite well, with minimal side effects.

Here you can see the MR-Linac machine that has allowed the SBRT radiation to be administered with such precision, allowing more potent doses of radiation to be given. I asked the radiologist if radiation on the tumor near the pancreas would have been possible without this machine. He has used SBRT radiation since 2008, so it would have been used, but the dose would have been less potent as the beam could radiate the surrounding area causing problems with his digestive system. With this machine, a constant MRI shows the exact location of the tumor in real-time. He had to hold his breath while the dose of radiation was given so that it was exact. Having this machine here now is such a gift! So, today we are celebrating that he had access to this cutting-edge treatment, and now, it is over. 

Since January, we’ve been through lots of ups and downs, and there have been times that we’ve wondered if he would make it through. However, today we are more hopeful than ever. We are humbled by all the support we have received and look forward to turning our focus to others who could use extra prayers and love. Neal A. Maxwell once said, “…the Lord requires a few intact individuals and families to help others manage their trials and tribulations, even though these roles often rotate." So, we wouldn't mind being more intact for a while and hope to incorporate what we have learned from so many of you on how to give such generous love and support.                                                                           

Our 43rd Wedding Anniversary

 Today Mark had the 2nd SBRT radiation session directed at the tumor in his liver. The first one was Tuesday, a week ago. The Friday session was canceled. The radiologist indicated that there has already been shrinkage with just one treatment. The last treatment for the tumor near the pancreas was last Wednesday, and it has continued to shrink. Mark is in much less pain and not taking any painkillers. When I asked what the odds were that the tumors would be completely destroyed with this therapy, the doctor said it was about 90%! That's amazing!!

SABR and SBRT are abbreviations for the same thing: Stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiation therapy (SBRT), is a cancer treatment that delivers extremely precise, very intense doses of radiation to cancer cells while minimizing damage to healthy tissue. 

We learned that the side effects of this radiation are cumulative; therefore, nausea and extreme fatigue continue to increase. It takes 3-5 weeks after the treatments are complete before Mark starts feeling better, and another 3-5 weeks before the side effects are gone. Hopefully, by September, he will be back to normal. Hearing that today was a bit disappointing for him. He is so tired of feeling crummy and anxious to get going on his growing to-do list. How we appreciate all of the help, love, and support we have received from so many!

Yesterday, we celebrated our 43rd wedding anniversary with some of our children and grandchildren, which brought us such joy! How well I remember wondering if we would make it to our 35th, and here we are, with hope for more to come.